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20100062 | MP/H Rules/Histology--Lung: How is histology coded when there is a lung biopsy compatible with non-small cell carcinoma and regional lymph node biopsies compatible with adenocarcinoma? See Discussion. | Which histology has priority when the pathology specimens reveal different histologies in the primary site and the regional lymph node? Do we assume the lung biopsy is the most representative tumor specimen because it is from the primary site and code to 8046 [non-small cell carcinoma] or should we use rule H5 and code to 8140 [adenocarcinoma, NOS] because adenocarcinoma is a more specific histology than non-small cell carcinoma? | For cases diagnosed 2007 or later, code histology based on a pathology report from the primary site whenever possible. Code histology to 8046/3 [non-small cell carcinoma] for the case example provided. | 2010 |
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20100028 | Primary site/Histology--Head & Neck: How are these fields coded when the final diagnosis for a skull based mass is "neuroendocrine carcinoma" and the IHC studies are incompatible with a brain/spinal cord primary (ependymoma)? See Discussion. |
The pathology report final diagnosis is, "skull base mass, biopsy: neuroendocrine carcinoma, see note. NOTE: Ancillary IHC studies reveal ...the IHC signature is incompatible with ependymoma. The constellation of findings is diagnostic of well differentiated neuroendocrine carcinoma." The site/histology combination of C410 and 8246/3 is 'impossible' by SEER edits. There is no override. What is the correct primary site and histology? |
According to our subject matter expert physician, this unusual case is most likely a sino-nasal tumor (some variant of esthesioneuroblastoma [olfactory neuroblastoma]). Code to nasal cavity [C300] as indicated in ICD-O-3 by site-associated topography code attached to the morphology code for olfactory neuroblastoma [9522/3]. |
2010 |
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20100070 | Histology--Heme & Lymphoid Neoplasms: How is this field coded for a follicular lymphoma, grade 2 of 3, predominantly nodular? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code histology to 9691/3 [Follicular lymphoma, grade 2]. Nodular lymphoma is an obsolete term once used to describe follicular lymphoma. (See Appendix A, Table A3)
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2010 | |
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20100081 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: Should a single primary be accessioned with the histology coded 9732/3 [multiple myeloma] when a patient is diagnosed initially with a plasmacytoma on an excision and a single bone marrow biopsy showed only 4% plasma cells, then the subsequent workup led to a clinical diagnosis of multiple myeloma? See Discussion. | This patient had a plasmacytoma removed from the sphenoid sinus and was started on Dexamethasone. The patient had a bone marrow biopsy with 4% plasma cells. A statement in the hematology notes read, "it can increase the rate of false negative results with a bone marrow biopsy." The bone marrow biopsy was done 15 days after the surgery for the plasmacytoma.
Workup yielded the diagnosis of multiple myeloma. Per a statement in hematology notes, "I found her having 4% blasts, atypical plasma cells in the bone marrow biopsy and also lytic lesions involving the T7 and lucencies involving L4 and L5 vertebral bodies and also the upper sacrum. The PET-CT scan did not show significant metabolic activities in those lesions. The patient had a small amount of Bence-Jones in the urine and also an abnormal kappa to lambda ratio in the serum. The ratio was 12 to 1. The beta 2 microglobulin was 1.4. The albumin in the serum was 3.4. Based on that, the patient has been diagnosed with Durie-Salmon stage III in ISS stage II multiple myeloma."
The abstractor notes for multiple myeloma state that the diagnosis is made when the proportion of plasma cells in the bone marrow is 10% or greater. Should a diagnosis of MM be accessioned and coded when the bone marrow is less than 10% plasma cells, but a clinical diagnosis of MM is made? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accept the physician's diagnosis of multiple myeloma [9732/3]. Code the multiple myeloma as a single primary using rule M8 if there was only ONE positive biopsy. Code as multiple primaries (both the solitary plasmacytoma and multiple myeloma) using Rule M11 if there are TWO positive biopsies, one confirming the chronic neoplasm and the other confirming the acute neoplasm.
Per the Heme DB Abstractor Notes: The registrar DOES NOT CODE plasma cell myeloma based on the percentage of plasma cells. There must be a diagnosis of plasma cell myeloma. In addition, a clinical diagnosis of plasma cell myeloma may be made based on amyloidosis with associated renal impairment, anemia and/or hypercalcemia supported by radiologic evidence of multiple lytic bone lesions. he biopsy confirmed plasma cell malignancy (plasmacytoma) and the clinical workup confirmed myeloma.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2010 |
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20100007 | MP/H Rules/Histology--Melanoma: Regarding SINQ #20081044, when would you apply Rule H6 rather than Rule H5 for a cutaneous malignant melanoma given that you normally always have a specific cell type mentioned? | For cases diagnosed 2007 or later, Rule H6 is used when you do not have a specific cell type other than regressing melanoma, or malignant melanoma, regressing. If you have regressing melanoma with a specific cell type, apply rule H5. | 2010 | |
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20100090 | MP/H Rules/Histology: How is histology coded for a diagnosis of "poorly differentiated endometrioid adenocarcinoma intermixed with osteoid sarcomatous component, consistent with malignant mixed mullerian tumor with heterologous (osteosarcoma) elements"? Is malignant mixed mullerian tumor synonymous with carcinosarcoma? See Discussion. | Given that there is no mixed code for these histologies, can the numerically higher code be used per H17 (malignant mixed mullerian tumor [8950/3]) using the logic of the MP/H rule for other sites? If so, should this histology be coded as 8980/3 [carcinosarcoma] rather than 8950/3 [malignant mixed mullerian tumor]? | For cases diagnosed 2007 or later, code histology to 8980/3 [carcinosarcoma]. Recent literature states that carcinosarcoma is synonymous with mixed mullerian tumor. Mixed mullerian tumor is an obsolete term and should not be used. | 2010 |
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20100061 | MP/H Rules/Histology: The 2010 SEER Manual has omitted some useful information in the Histologic Type ICD-O-3 section, specifically the statement of "Do not revise or update the histology code based on subsequent recurrence(s)". Will this statement be added to the revisions of the MPH rules? See Discussion. | Example: A 2005 diagnosis of left breast lobular carcinoma [8520/3], followed by a 2009 diagnosis of left breast ductal carcinoma [8500/3]. Rule M10 states this is a single primary, but there is no information in the Histology rules (Multiple Tumors Abstracted as a Single Primary) that the original histology should be retained, thus a person could potentially use these rules to change the original histology to 8522/3 [duct and lobular carcinoma] per rule H28. | We will reinstate the instruction not to change the histology code based on recurrence in future versions of the histology coding instructions. However, this instruction may not be applicable to all anatomic sites. It will be reinstated on a site-by-site basis. You may also refer to the instructions on Page 7 of the 2010 SEER Manual under the heading "Changing Information on the Abstract." | 2010 |
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20100074 | Laterality--Melanoma: For a melanoma case, does the term "mid" imply that the tumor is in the midline when the site is the skin of back (trunk)? | Yes. When the location is described as mid-back or mid-chest with no indication of left or right, assign laterality code 5 [midline]. | 2010 | |
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20100093 | MP/H Rules/Multiple primaries: Please clarify how rule M10 for Other Sites was developed and how a "recurrence" of the tumor after one year was determined to be a new primary? See Discussion. |
What is the expected outcome or result of rule M10? Specifically, for soft tissue sarcomas, why is a recurrence after one year a new primary instead of a recurrence? |
For cases diagnosed 2007 or later: Rule M10, tumors occurring more than one year apart are multiple primaries, was developed to differentiate a new primary from a recurrence. The rule was developed with the concurrence of the CoC site-specialty physicians and the SEER consulting pathologist. There was agreement between all of the CoC site teams and the consulting pathologist that statements of recurrence should not be relied upon to rule out a new primary. The time limits for each site were set based on information from peer-reviewed articles on tumors occurring in the same site and studies using molecular studies to confirm whether or not the tumors were histologically similar. Determination of the time limit for the "other sites" rules was probably the most difficult because so many sites are involved. However, the specialty-physicians felt that one year was an appropriate length of time to apply to these sites. |
2010 |
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20100046 | Heme & Lymphoid Neoplasms: Is a clinical remission sufficient to change the tumor status to "disease free" for a patient on long-term chemotherapy for a diagnosis of either a chronic hematologic disease, such as CML, or a myeloproliferative disorder, such as essential thrombocythemia? See Discussion. |
For some patients with chronic hematologic diseases, the disease/recurrence status could change frequently as chemotherapy is started and stopped over an extended period of time. Should the tumor status for these cases always be "not disease free"? When the physician documents the patient is in clinical remission, does their status change to "NED or disease free?" There seems to be a lot of variation across the US in how registrars are coding this field. Clarification would be appreciated. |
The term "disease free" is not used in a standard fashion for hematopoietic and lymphoid neoplasms.
Code the cancer status to free of disease when the physician indicates NED. For hematopoietic and lymphoid neoplasms, a physician's statement of NED, disease-free, clinical remission or no evidence of disease at this time, should be recorded with cancer status to disease free. The term "disease free" or NED means that there is no clinical evidence of disease. |
2010 |
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